I have done 3 now and I do them just like a regular quilt. When top is done, sandwich all the layers and then pin. I hand quilted mine with echo stitching around pics and words (as Maine ladybug mentioned) Did a plain running stitch around blocks depending on what design you used. I had one sent out and done by LA and it turned out nice too. You don't need to quilt really close together. Mostly just to hold everything in place.